Medication guide

Eszopiclone (Lunesta)

What is eszopiclone?

Eszopiclone is known as Lunesta in the United States and Japan alike (ルネスタ on Japanese packaging) and as Lunivia in the UK, where the closely related zopiclone (Zimovane) is also prescribed; it's all the same medicine. It belongs to the "Z-drug" (non-benzodiazepine) group of sleep medicines: it calms the brain's activity at night to help you fall asleep and stay asleep, and it's meant as short-term help while sleep settles.

How is it different from other sleeping pills?

Works from the first night: no build-up period
Not a controlled substance in Japan: unlike zolpidem and zopiclone, so the in-person-first rule for online prescribing doesn't apply to it, and ordinary import rules apply when travelling
A little longer-acting than zolpidem: helps when waking during the night is part of the problem
Approved for insomnia broadly: the Japanese approval carries none of the exclusions on zolpidem's (insomnia with schizophrenia or bipolar disorder)

What is it used for in Japan?

Insomnia.

What it targets: both the start of the night and staying asleep, thanks to its slightly longer action than zolpidem; a fit when waking during the night is part of the problem.

How does it help?

It quietens the brain's activity at night so you can fall asleep more easily and stay asleep longer. It works the same night, taken just before bed, and it works best as a short bridge alongside good sleep habits.

What should I tell my doctor before starting?

A few situations rule it out entirely; your doctor will choose something else if any of these apply:

A past allergic reaction to eszopiclone or zopiclone
Myasthenia gravis (a muscle-weakness condition)
Acute narrow-angle glaucoma

And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:

Severely reduced lung function (for example from emphysema or asthma): the label says it is not given in that case unless there is no alternative
Liver or kidney problems (a lower dose is used when they are serious)
A heart condition
A previous episode of acting out in your sleep (sleepwalking and the like) on this medicine
Other sedating medicines, or regular alcohol use
Being older: a lower dose is used
Pregnant, planning to be, or breastfeeding (see the section below)

How do I take it?

Only right before bed, and only on nights you can give a full night to sleep.

Take it immediately before lying down; avoid taking it with or just after a meal, which weakens the effect
Don't take it if you might need to get up and function during the night
If you forget it, just skip that night. Never take a second dose in one night
Avoid alcohol; the Japanese label warns that the two strengthen each other's effects
Older adults start at a lower dose

What side effects should I expect?

Most are mild. Not everyone gets them.

A bitter or unpleasant taste (the most commonly reported effect, in roughly a third of people in a long-term Japanese study): if it bothers you, tell your doctor
Drowsiness, or grogginess the next morning
Headache
Dizziness
Dry mouth

If anything is bothering you, tell your doctor; there's often a way to adjust.

Finally, one thing that is rare (most people never experience it) but good to know:

Very occasionally, people carry out activities while not fully awake (walking, eating, even driving) with no memory of it afterwards. If you or someone around you notices this, stop the medicine and tell us; the Japanese label says stopping it should be considered after an episode like this

Will I become dependent? How do I stop safely?

It can be habit-forming with regular long-term use, so it's used short term, at the lowest dose that works, and stopped with a plan. The Japanese label warns against continuing it for a long time without a clear reason. The body can come to rely on Z-drugs, and stopping suddenly after regular use can bring a few nights of rebound poor sleep, anxiety, unusual dreams, or nausea, so never stop suddenly on your own; your doctor lowers it gradually or shifts to as-needed use. The aim is a short bridge while sleep recovers.

Can I drive while taking it?

No. Don't drive after taking it, and be alert to leftover drowsiness the next morning. Because the effect can carry into the next day, the Japanese label instructs that patients on eszopiclone shouldn't drive or operate dangerous machinery. If next-morning sleepiness keeps happening, tell your doctor; the dose or the medicine can be changed.

What about pregnancy and breastfeeding?

Tell your doctor early; this one is planned case by case. The Japanese label allows eszopiclone in pregnancy only when the benefit is judged to outweigh the risk, and notes that babies exposed to it late in pregnancy can show withdrawal symptoms after birth. With breastfeeding, eszopiclone is avoided: it passes into milk and can make the baby drowsy. Don't start, stop, or continue on your own; our guides to medication in pregnancy and medication while breastfeeding cover the wider picture.